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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1761880

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Case Details

VAERS ID: 1761880 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-10-04
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Painful respiration, Pulmonary embolism, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: AML post MUD SCT 6/2019
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: EC visit and subsequent admission for pain with breathing, cough, vomiting. Diagnosed with sub-segmental pulmonary emboli


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